SIGNS AND SYMPTOMS
Episcleritis presents as a relatively asymptomatic acute onset redness in
one or both eyes. Typically, you'll observe a sectoral injection of the episcleral and
overlying conjunctival vessels, although the redness may be diffuse throughout these
tissues. Occasionally, there may be a translucent white nodule centrally within the
inflamed area (nodular episcleritis). While some patients complain of mild pain or
tenderness to the affected region, particularly upon manipulation, often there is no
associated discomfort. The cornea remains clear in this condition, although long-standing
or recurrent episcleritis may lead to dellen formation. There is no associated anterior
A benign inflammatory condition of the external eye, episcleritis is seen
most commonly in young adults. Women appear to be affected slightly more often than men.
The disorder is idiopathic in the majority of cases, however in certain instances there
may be an association with some underlying systemic disease such as rheumatoid arthritis,
polyarteritis nodosa, systemic lupus erythematosus, inflammatory bowel disease,
sarcoidosis, Wegener's granulomatosis, gout, herpes zoster virus or syphilis.
Most cases of episcleritis are self-limiting, meaning that they will
resolve spontaneously within two to three weeks even if the patient does not undergo
treatment. However, patients who are experiencing discomfort may benefit from a regimen of
topical anti-inflammatory agents and lubricants.
Typically, prednisolone acetate 1% or fluorometholone acetate applied
Q3-4H will speed resolution and decrease the tenderness. The patient may use cold
compresses and artificial tears liberally if discomfort persists. More severe cases,
particularly nodular episcleritis, may require oral NSAIDs to quell the inflammation.
Re-examine patients weekly. For those on topical steroid therapy for
more than two weeks, perform tonometry to monitor for elevation of IOP. Because of the
association with systemic disorders, refer patients with extremely severe presentations or
more than three recurrences for a medical evaluation.
- Episcleritis is one of those conditions, like subconjunctival hemorrhage,
that typically looks worse than it is. Reassure patients that they do not have
"pink-eye." However, be sure to distinguish this condition from the more severe
scleritis, which is far more painful and may have more serious implications.
- In severe or diffuse cases in which the differential diagnosis is more
difficult, blanching the conjunctiva and episclera with phenylephrine 2.5% will allow for
better evaluation of the underlying sclera.
- When searching for the cause of episcleritis, remember that inflammatory
bowel disease, ulcerative colitis, and Crohn's disease are the most commonly associated
Other reports in this section
Allergic Conjunctivitis &Vernal
Chlamydial & Gonococcal Conjunctivitis
Superior Limbic Keratoconjunctivitis (SLK of
Conjunctivitis with Pseudomembrane
Giant Papillary Conjunctivitis